Wednesday, November 15, 2017

The Hardest Part Of Being An Anesthesiologist, Part 2

In the first part of this series, I opined on how the anesthesiologist is not in fact the patient's savior in Preop Holding, unlike what another blogger may have written. There are much harder and more frustrating aspects to anesthesiology than holding a patient's hand. Here, in no particular order, are what I think are some of the more difficult characteristics of this job to get used to.

1. Early morning work hours. If you're a night owl like me, this is a tough transition that your body never really gets used to. Getting up at 5:00 AM to get ready to go to work is not a natural activity for most people. Even now, on weekends I allow my natural circadian rhythm to get me to bed by 1:00 AM and wake up around 8:00 AM. So weekdays are a struggle to get myself into bed early enough to get a good night's sleep. Of course I know some colleagues who are natural early risers and get up at 4:00 AM to go for a brisk morning run before work. I hate them.

2. Unpredictable work schedule. If you're looking for a 9 to 5 job, anesthesiology is not for you. Sure you can find some locations like at academic centers where you do more predictable shift work and are more likely to go home at a set time. But in academia you have other activities to keep you working long hours like giving lectures and attending endless faculty meetings. Most anesthesiologists in private practice have to do the cases the surgeons are booking for that day. One day your work may be done by 1:00 PM. Another day it could be 8:00 PM. And there is no way to tell more than 24 hours ahead of time what kind of day you'll have. You wind up missing a lot of dinners and occasionally surprising your kids when you are able to pick them up from school. It's just that kind of job.

3. You're not in charge. Surgeons bring in the patients who bring the money to the medical facility. They have all the leverage to run the OR as they see fit. You can't dictate when to start the day or when it should end. You don't get to tell people what kind of case you want to do today; you do whatever is offered. Calling in sick is a huge burden because it's not like they have a spare anesthesiologist just sitting around to pick up the work. So if you're an assertive person who doesn't like being told what to do, this isn't the field for you.

4. You feel more dispensable than you would like. You earned your medical degree like every other doctor. You spent years getting trained and board certified to practice anesthesiology. Yet once in practice you'll often get the feeling you're opinion is not taken seriously. A common lament is that if you try to cancel a case, the surgeon will simply ask for another anesthesiologist. It's as if all your years of medical training to provide the safest patient care means nothing. Unfortunately, some of your colleagues will betray you and agree to do it, making you feel small and stupid. Yes you probably did the best thing for the patient but the patient probably did fine during the case. The same can't be said for your reputation in the OR afterwards. You've now become the anesthesiologist that likes to cancel cases.

5. High stress levels especially when on call. Anesthesiology is a high stress career to begin with. Patients can unpredictably crumple within seconds and you have to know how to deal with it. When you're on call, it is ten times worse. The difference is that elective cases are usually on healthier patients and you've had time to evaluate the cases hours beforehand. When you're on call, it can be anything that rolls through the OR doors. It could be procedures as diverse as a five year old with post tonsillectomy bleed to a ninety year old with a fractured hip. A crash C-section on a drug addicted mother to twenty something year old gangbanger with multiple gun shot wounds to the chest and abdomen. While the surgeon only operates on the part of the body he is trained to work with, the anesthesiologist has to be a master at everything. Talk about high stress.

6. You have to act cheerful all the time. The surgeon and the patient get to be grumpy. But nobody likes a dour anesthesiologist. You can't have mood swings and yell at the OR staff like surgeons can get away with. You're supposed to have a calming pleasant personality that's just borderline dull so that everybody in the room feels reassured. A loud angry anesthesiologist will not last in his job for very long. Same can't be said about surgeons.

7. There is very little patient rapport. As I previously mentioned anesthesiologists are the staff with the least amount of time to spend with the patient. The patient loves their surgeon and that's why they're having a procedure with him. The nurses usually have more time to talk with the patient in preop and establish a relationship. You're lucky to get in three questions in preop before people start pacing impatiently to get the case started. That's why around Christmas time the surgeons and nursing staff get all the gifts from patients and the anesthesiologist (who the patient rarely recalls) get to watch other people open them.

8. And finally anesthesia is a very isolating job. If you're used to the team approach in medicine as a resident, you'll quickly discover that anesthesia is a one man show. While internists and surgeons run around in packs, the anesthesiologist walks alone into the operating room and goes home alone. We have no idea what is going on in the OR next door to us. All our cases finish at different times so it's almost impossible to get colleagues together after work to hang out. So if you feel lost without your posse around, anesthesia is not the job for you.

Now don't get me wrong. I love my job as an anesthesiologist. In fact, anesthesiology is considered one of the best jobs in America. However, anyone contemplating going into this field should go in with eyes wide open and understand that it, like any other medical field, has its advantages and disadvantages. Despite this list, for me the rewards of anesthesiology far outweigh the negatives.